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Why some doctors are in favour of medical cannabis

The politics of medical cannabis may be complicated. But for some people it makes a world of difference in relieving pain, nausea, seizures, and other symptoms. With the recent political debate around medical cannabis trials, you could be forgiven for thinking that the notion was something altogether new.

In fact, cannabis has been used medicinally for thousands of years in India and Asia. It was introduced to western medicine in the mid-nineteenth century by an Irish doctor William O'Shaughnessy, upon his return from service in India, and become a popular therapy around the world. Even former US president Richard Nixon's 1972 National Commission on 'marihuana' supported studies of its use in the treatment of conditions such as glaucoma, migraine and cancer (although Nixon subsequently ignored his own Commission's findings and instead declared a 'war on drugs'). The criminalization of marijuana saw it swiftly fall from medical favour. However, it seems that medical cannabis's star is once again rising, with some evidence suggesting it may offer considerable relief in conditions where few other treatments are able to help.

Making people more comfortable

Cannabis's therapeutic benefits stem from the way it stimulates with the body's own method of making us feel good, known as the endocannabinoid system, explains Emeritus Professor of Anaesthesia Laurence Mather, from the Northern Clinical School at the University of Sydney. "The endocannabinoid system in the body is not a pain relieving system like the endorphin system, like for morphine-type things, it's more a general wellbeing system, and it works by making people feel more comfortable with themselves," Mather says.

"It doesn't ablate pain, it makes the body more accepting." Cannabis helps with a very specific type of pain that does not appear to respond well to pain relieving treatments, such as opioids or non-steroidal anti-inflammatory drugs (NSAIDS). "It does not work, for example, in post-operative pain … and in acute pain such as from a surgical incision," Mather says. However, it is showing considerable promise in treating what is called 'neuropathic pain', which generally refers to pain that stems from diseased or damaged nerves. For example, researchers in the United States are testing the use of cannabis to treat the pain associated with sickle cell disease – a condition in which mutated blood cells can cause lifetime chronic pain that has been described as being worse than the pain of labour or cancer.

Stimulating appetite

The appetite stimulating effects of marijuana – more commonly known as 'the munchies' – have also proven useful in countering the bodily wasting associated with a range of conditions from HIV/AIDS to cancer. "That was observed back in the '60s and '70s, particularly by the recreational users of the time … they noticed the incidence of weight gain was more favourable in those that used cannabis than others," Mather says. This observation led to the development of a drug called dronabinol, which is a synthetic version of the main psychoactive component of cannabis – tetrahydrocannabinol (THC). This drug is used not only to treat weight loss associated with HIV/AIDS and cancer, but also the nausea and vomiting often associated with cancer therapies.

Other conditions

While THC is the most famous of cannabis ingredients, it is not the only one proving beneficial in the medical arena. Another drug, nabiximols, an oral spray which is available in Australia under the brand name of Sativex, contains both THC and cannabidiol, and is used for the treatment of muscle spasms associated with multiple sclerosis. Given cannabis's potential to alter our mood, thinking and behaviour, it should come as no surprise that it's also being investigated for treatment of psychological disorders such as post-traumatic stress disorder. A recent US study found a 75 per cent reduction in PTSD symptoms with the use of medical cannabis, and in many US states medical cannabis is approved for use in individuals with PTSD. There is also growing support for the use of cannabis to treat severe childhood epilepsies, such as Dravet's syndrome, with anecdotal evidence from parents suggesting cannabis drastically reduced the frequency of their children's seizures.

Fewer side effects

Likewise, some argue that medical cannabis could provide a much safer and more pleasant alternative to the existing pain relief options used in palliative care. "The side effects of many things that are used for treating these conditions such as heavy duty pain and things of that kind – treating them with opioids or treating with NSAIDS – are far more dire than they are from cannabis," says Mather. "People can die from morphine, they stop breathing; people can die from paracetamol because it buggers their livers, people can die from NSAIDS because it buggers their kidneys, but cannabis doesn't do any of these things." Like any drug, cannabis has its side effects, although what's interesting with medical cannabis is that the effects most sought after by recreational users are generally the effects most avoided by medical users, says emergency medicine specialist Dr David Caldicott, from the Australian National University and Calvary

Hospital in Canberra.

"The product that is beginning to emerge globally is one that is bred and used for largely recreational purposes and so these are strains now which contain a much higher concentration of the psychoactive component, which is THC, and that isn't necessarily the most useful component," says Caldicott. "Many people who consume this product medicinally actually don't like this effect, they choose strains, say for example in the US, that are much lower in THC concentration and higher in the cannabidiol concentrations." In parts of the world where medical cannabis is legal, considerable effort has gone into developing strains of marijuana that are carefully tailored for medical use, to reduce the unwanted side effects and boost the more desirable ingredients.

Lack of good data

But medical cannabis presents a conundrum for medical professionals. Its illegality in large parts of the world means most medical users are self-medicating and this also makes it a difficult drug to study in clinical trials. As a consequence, a significant proportion of medical cannabis research is based on self-reported use and outcomes, rather than large, carefully-designed, randomised trials, says Professor Ian Olver, head of the Cancer Council Australia. "Probably two decades ago I remember sitting on a panel that reviewed the evidence [for medical cannabis], and in most cases the evidence is anecdotal," says Olver. As a result, he is cautious about the idea of more widespread availability of medical cannabis but acknowledges that there may be some patients for whom it is their only recourse to relief.

"If you've got a patient who's been through conventional therapy and has not responded, you're sympathetic to them if they find something that's worked, but that's quite different to saying something should be widely available for everyday use of pain," he says. Olver says there is also concern about the possible side effects of smoking marijuana, even for medical purposes, as this could introduce cancer-causing chemicals into the lungs. However Caldicott says there are other methods of delivery being considered, such as e-cigarettes, which would not only be more palatable for non-smokers but could avoid the potential side-effects of smoking. The active components of cannabis can also be infused into tinctures, which could be a useful option for use in children.

Ultimately, the medical cannabis debate is not about making it widely available for a broad range of health conditions – as currently occurs in many states in the US – but about giving a small number of patients an option where they may have none. "Medical cannabis is never going to replace paracetamol," says Caldicott. "We're not talking about the sky falling in, we're talking about a niche market which would be very tightly regulated."

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Outstanding article! Plus, some new data also shows that, at least here in the U.S., states which have allowed medical marijuana to be used have shown an average drop of 25% in the overdose-related hospital admissions and deaths related to prescription narcotic pain pills. So that, if nothing else, is a fairly good reason for allowing it. Obviously, the detractors would say that you are trading one addiction for another, but the truth is that you are trading up. And I think very few would have an issue with choosing marijuana over opiates.

Good point, in Australia we also have a rising OD rate from prescription opioids. Our public health system is far more comprehensive then that of the US so the parentage of chronic pain patients left with medication as the only financially viable option is miniscule in comparison. In turn the available opioids for abuse is reduced. But even with the best healthcare we're seeing a shift in attitude by medicos that are ready to piss on a spark pluck to arrest this climbing death rate and its medicine pushing for the rollout of cannabis on prescription.

The medical applications debate here hasn't mentioned the "one addiction for another" they are more focused on the best possible outcome for the patient and the public at large. Obviously we have the recalcitrant dinosaurs holding on to 20th century drug ideology but even our prime minister is just ignoring them and hopping they will go away prescription cannabis looks like a certainty here, the formality's of trials will be over long before the current federal government administration could be voted out of office and as they control the public heath budget the states will have to fall in line.

Medical application of cannabis in Australia has the advantage of not making the mistakes made by the medical marijuana in the US. There is no focus on THC or the marijuana plant, we are only interested in it as a pharmaceutical in the same way poppies are grown for there extracts so will marijuana. This cannabis oil extract we hope will be kind of a Medical Marijuana 2.0 and its this new modal for the application of MM 2.0 that is driving the publication of articles such as this by the government owned broadcaster.

MM 2.0 as a medicine is to be produce with a focus not on THC levels but on the level of impurity's in the same way we produce the extracts from opium poppy. Australian industry is the best placed in the world to move forward on MM because the infrastructure needed for mass extraction and refining already exists and is legally exempt from the UN charter on narcotics, I don't see a problem bundling cannabis in with opium poppy. Its positive commercially and is needed by public health its a win win.

I agree. And our opiate/opioid prescription problem here is at epidemic proportions, for the simple fact that our medical system has historically run under the idea that a simple pill will cure everything. There is no more getting to know your patient or understanding the underlying factors involved with their particular problem. No, there is money to be made, so take this pill and.....NEXT!

While I favor the free market system over the more socialistic ones, the sad truth is that neither one is really worth a damn.....it is either the wild west or prison-like, with no "happy medium" present. And the other sad truth is that a very small percentage of people who use MMJ really need it. We are just stoners who like to smoke pot and have been presented-finally-with a means of doing so that does not entail the risk of long-term incarceration.

Personally, I have used cannabis for probably close to 35 years. The first 30 was for recreational reasons, with the last 5 being for medical. Is it necessary? Well, a case could be made either way, I suppose. As related in my blog, I was on a truly staggering number of different natural and semi-synthetic opiates/opioids, with a dosage well in excess of what should have been prescribed.

Now, I am on.....none. I credit MMJ with that, but I could have done it on my own and without Maryjanes help. Not as easy, not as fast, and certainly not as (relatively) painlessly, but I COULD have done it. If I had wanted to. Which I didn't. Why?

Because I like using cannabis! I have made the transition back to not needing it for medical reasons, but continuing to use it anyway. I can walk out on my front porch, sit in my chair, and fire up a joint or pipe, and nobody will say a thing. I don't have to hide, I don't have to engage in criminal or addictive behavior, I don't have to deal with scum in order to purchase my product, I can go to a safe and well-lit establishment that is licensed and regulated, pick and choose between a staggering number of different products, and drive back home.....all without ever having to worry about the law or being charged or arrested for smoking weed. I pay taxes which go towards my kids schools and other infrastructure in my community.